What are possible postoperative complications from the treatment of primary hyperparathyroidism?

Updated: Oct 02, 2018
  • Author: Lawrence Kim, MD, FACS, FACE; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Answer

Answer

For a full parathyroid exploration, postoperative hypoparathyroidism and hypocalcemia are concerns, but they are usually not a problem except when subtotal parathyroidectomy is performed. The nadir of serum calcium usually occurs 24-72 hours postoperatively. Many patients become hypocalcemic, but few become symptomatic.

Hypocalcemia after parathyroid surgery may be due to hungry bone syndrome where calcium and phosphorus are rapidly deposited in the bone. This is characterized by hypoparathyroidism and transient, but occasionally severe, hypocalcemia until the normal glands regain sensitivity.

If hypoparathyroidism persists, oral supplementation with calcium and vitamin D is required. Calcium citrate or calcium carbonate may be started at 2 tablets 4 times per day. Some patients require substantially more. Calcitriol is started at 0.5 mcg twice daily and increased as required. Patients in whom total parathyroidectomy and autotransplantation is performed can be expected to require temporary calcium supplementation.

If a recurrent laryngeal nerve is transected during parathyroidectomy, immediate repair is indicated. If the recurrent nerve is not known to be injured intraoperatively but dysfunction is suggested because the patient has developed new hoarseness, expectant management is chosen initially since most patients recover nerve function over a few weeks to months. Laryngoscopy is indicated to document both dysfunction and recovery of function.

A potential life-threatening emergency in the postoperative period is the development of an expanding hematoma in the pretracheal space. This complication must be recognized and treated immediately by opening the wound and evacuating the hematoma. If untreated, laryngeal edema may progress rapidly, causing airway obstruction.

Most small hematomas do not require treatment. A subplatysmal fluid collection may occasionally form, and these are usually treated adequately with a single aspiration. In a few cases, aspiration may need to be repeated. Rarely, a drain may need to be placed for recurrent fluid collections.


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